What is Ulcerative Colitis?

Reviewed by: HU Medical Review Board | Last Reviewed: December 2017. | Last updated: December 2021

Ulcerative colitis is a chronic (long-term) inflammatory disease that affects some or all of the large intestine.1 The different types of ulcerative colitis refer to the affected parts:

  • Ulcerative proctitis: inflammation of the rectum.
  • Pancolitis: inflammation of the entire large intestine.

Inflammation in the colon causes little sores to form.2 The little sores are called ulcers. They fill with pus and mucus.

What are the different types of inflammatory bowel disease?

Ulcerative colitis is part of a group of disorders called “inflammatory bowel diseases.” Another common inflammatory bowel disease is Crohn’s disease. These two inflammatory bowel diseases have similar symptoms, such as diarrhea and abdominal pain. It can be hard for patients and health care providers to tell these conditions apart. However, there are important differences in the type and location of inflammation.3

How are ulcerative colitis and Crohn’s disease different?

Ulcerative colitis affects the large intestine and rectum, whereas Crohn’s disease can affect any part of the digestive tract.1 People with Crohn’s disease have patchy areas of inflammation along the digestive tract (Figure). In contrast, people with ulcerative colitis have inflammation in one continuous area.1,2 In ulcerative colitis, only the innermost layer of the digestive tract wall is affected. Crohn’s disease causes inflammation through the entire thickness of the digestive tract wall.1,2 The procedure used to tell ulcerative colitis apart from Crohn’s disease is a colonoscopy with biopsy. [Adams, 2013, pg 701]

Figure. Crohn’s disease vs. ulcerative colitis

Side by side digestive tracts showing the location of inflammation in Crohn’s disease versus ulcerative colitis.

Ulcerative colitis affects men and women equally, as well as people of all races or ethnicities. In contrast, Crohn’s disease affects slightly more women than men. Crohn’s disease is more common in whites than people of other races or ethnicities.1 Both conditions are typically diagnosed in early adulthood.1,4

What are the symptoms of ulcerative colitis?

Typical symptoms of ulcerative colitis are rectal bleeding, diarrhea, or abdominal pain.1 The symptoms may start gradually or suddenly. About one-third of people with ulcerative colitis have non-digestive symptoms.1 These symptoms include arthritis, canker sores, or problems with the liver, eyes, and skin.

How is ulcerative colitis diagnosed?

The procedure done to confirm the diagnosis of ulcerative colitis is colonoscopy with biopsy.1 Your health care provider may also do some blood tests. These tests check for anemia, high platelet levels, or low levels of a protein called albumin. If the results are abnormal, they suggest that you have inflammatory bowel disease. However, many people with inflammatory bowel disease have normal results. This makes diagnosis incredibly difficult for some individuals. Your provider may also want a stool sample.

How is ulcerative colitis treated?

People with ulcerative colitis usually have periods of active disease followed by periods of recovery (remission). The goal of treatment is to achieve and stay in remission.1 Medical treatment is usually tried first. If you do not improve with medications, your health care provider may recommend surgery.1

A variety of medications are used to treat ulcerative colitis. These include:5

  • Anti-inflammatory medications
  • Corticosteroids
  • Medications that suppress the immune system
  • Biologic medications

Some of these medications can be taken as an enema or suppository.1,5 Taking the medication this way helps it get right to the inflamed areas. An enema involves injecting a liquid medication into the large intestine via the rectum. Rectal foams are used in the same way, except that medication is a foam rather than a liquid. A suppository is a solid medication that is inserted into the rectum, where it dissolves.

Your health care provider may also recommend oral, injectable, or intravenous medications. The best medication will depend on how severe the inflammation is and where it is located.

What are some of the complications of ulcerative colitis?

Complications of ulcerative colitis include:5

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